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Student Referral Form to SMHS Office of Student Support (OSS)
Please complete this form to initiate an advising meeting with the Office of Student Support.
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* Indicates required question
I am a:
*
Faculty or Staff member referring a student to OSS
Student who is self-referring
If you answered that you are a Faculty/Staff person referring a student, please provide your contact information (name, email, office number) below.
Your answer
If you are self-referring, what are your expectations from your meeting with OSS?
Your answer
Student Name (First & Last)
*
Your answer
GWID
Your answer
Program of Study
*
Your answer
Student Email
*
Your answer
Primary Phone Number
Your answer
When is the best time for a staff member to contact you/the student? *Note all times should be identified in Eastern Standard Time (EST)
*
Your answer
Referral Reason
Help Seeking: Approaching others for help
Mindset: Belief that own intelligence and academic talents can be changed and developed
Motivation: Perception that coursework is of value
Readiness: Ability to succeed in higher education
Self- efficacy: Belief that academic tasks can be successfully achieved
Sense of belonging in SMHS: Ability to connect with the SMHS community
Time Management: Engaging with time management practices
Other:
Academic Skills & Strategy Areas
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Academic integrity
Academic probation
Class attendance and participation
Managing academic stress/anxiety
Note-taking
Overcoming procrastination
Personal organization
Social challenges impacting academics
Study habits
Test-taking/Exam prep (strategies and techniques while taking the actual exam)
N/A
Other:
Required
Additional Support Services
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Career Planning (Resume/CV, LinkedIn, Interview Skills, Cover Letter)
Financial Literacy
Stress Management & Wellness
Writing Skills
N/A
Other:
Required
Is there a particular class that the student is / you are struggling in? If so, please list the class.
Your answer
Please provide any additional comments you think are important.
Your answer
Are you / is the student currently utilizing any university services such as Writing Center, Health Center, DSS, Program Advisor etc?
Your answer
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